Replacement of Left Ventricular Assist Device Inflow Cannula Using a Right Angle Atrial Cannula

Greenleaf, C.E.; Binsalamah, Z.M.; Adachi, I.

Annals of Thoracic Surgery 109(5): E389


ISSN/ISBN: 1552-6259
PMID: 31982441
DOI: 10.1016/j.athoracsur.2019.11.060
Accession: 069750021

Download citation:  

Article/Abstract emailed within 0-6 h
Payments are secure & encrypted
Powered by Stripe
Powered by PayPal

Deep sternal wound infections (DSWI) often require flap reconstruction to obliterate dead space and provide healthy soft tissue coverage. A better understanding of risk factors for complications after Dswi flap reconstruction may improve operative management. A retrospective study (2007-2018) was conducted of all patients with Dswi after cardiothoracic procedure referred to a single reconstructive surgeon for flap reconstruction. Patient and operative factors were reviewed, including procedure types and outcomes. Predictors of morbidity and mortality rates were analyzed. A total of 119 patients requiring flap reconstruction for Dswi met inclusion criteria. Unilateral (49.6%) or bilateral (40.3%) pectoralis muscle flaps were performed most frequently, followed by vertical rectus abdominis myocutaneous (VRAM) (4.2%), omental (4.2%), and omental/pectoralis flap combination (1.7%). Superficial surgical site infection (SSI) was the predominant postoperative complication (17.6%). Débridement/revisional procedures were required in 19 patients (16%), and flap failure occurred in 5 (4.2%). Overall 30-day mortality was 15.1%. End-stage renal disease (P =.002), congestive heart failure (P =.049), low albumin (P =.004), cardiopulmonary bypass time (P =.0001), need for open chest (P =.020), and high American Society of Anesthesiologists Physical Status Classification (P =.003) were associated with higher mortality. By multivariate analysis, multidrug resistance was predictive of any postoperative complication (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.3-23.2; P =.018), Vram was predictive of Ssi (OR, 9.6; 95% CI, 1.4-66.4; P =.022), and end-stage renal disease (OR, 8.57; 95% CI, 1.06-69.1; P =.044) was predictive of higher mortality. Pectoralis muscle flaps are the workhorse for complex sternal wound coverage, but complications after flap reconstruction for DSWIs remain high. In particular, end-stage renal disease, Vram reconstruction, and multidrug-resistant infection may predict a complicated postoperative course in these patients.